Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program
| Policy Information | Policy Details |
| Policy Number: |
175 Doctor of Medicine (MD) Program |
| Original Policy Approval Date: | November 7, 2023 |
| Implementation Date: | Fall 2025 |
| Next Policy Review Date: | 2030 |
| Responsible Committee or Office: | School of Medicine |
1. Purpose
The purpose of this policy is to establish and communicate a framework of professional conduct for students in the TMU School of Medicine’s Doctor of Medicine (MD) program, to outline expectations for standards of professional behaviour, and to ensure the delivery of safe, effective and ethical patient care by fostering the development and maintenance of high standards of Professionalism.
Professionalism is a key learning outcome for medical education in Canada as set out by the CanMEDS 2015 framework. Accordingly, it is also a key learning outcome for TMU’s MD program. As health professionals, physicians are committed to values and standards of care that govern the profession while improving health and well-being for patients, colleagues, health professionals and society. As future physicians, MD students learn and demonstrate high standards (personal and as physician-learner) through ethical, equitable, anti-discriminatory, inclusion-focused action in care, involved community activities, and in their personal life. They are accountable to the standards of the medical profession, our school, university, and society.
Addressing Lapses in Professionalism is important to ensure students receive a safe, equitable and inclusive learning environment as well as adequate support in developing their professional identity and its associated competencies in the practice of medicine across their medical education and in their provision of safe and equitable patient care.
2. Application and Scope
This policy is applicable to all students in the School of Medicine’s MD program, including all required and independent self directed and service learning experiences. This policy involves student conduct that has an identifiable and reasonable connection to patient safety, the interests of the School and/or members of the School, TMU, affiliates of TMU’s School of Medicine or the community.
3. Definitions
3.1 Lapse in Professionalism
Conduct or behaviour - in isolation or as part of a pattern - that falls short of the professional conduct standards as defined by the relevant School of Medicine and University policies and other elements outlined in this policy.
3.2 Learner Affairs Unit (LAU)
Learner Affairs Unit in the School of Medicine.
3.3 Professionalism
Medical Professionalism is defined as “the translation of the values of the profession – compassion, service, altruism, and trustworthiness – into action. Medical Professionalism is demonstrated when these values are upheld in the everyday interactions that comprise each doctor’s own medical practice.”1
3.4 School
The School of Medicine at Toronto Metropolitan University.
3.5 Student
A student in the School of Medicine’s MD program.
3.6 MD Program
The formal learning process of courses approved for the MD program’s curriculum at the School of Medicine.
3.7 MSPR
Medical Student Performance Record.
3.8 UGME
Undergraduate medical education.
3.9 University
Toronto Metropolitan University.
1 CPSO Practice Guide :Medical Professionalism and College Policies, p. 2.
4. Principles
4.1 The values stipulated in the University’s Senate Policy Framework are applicable and fundamental to this policy.
4.2 This policy is based on the legal and ethical standards established by the Association of Faculties of Medicine of Canada’s (AFMC’s) (PDF file) Canadian Undergraduate Deans Statement on Professionalism (external link) ; the Canadian Medical Association Code of Ethics and Professionalism (external link) ; and (PDF file) The College of Physicians and Surgeons of Ontario; The Practice Guide: Medical Professionalism and College Policies (external link) . In the case of any professionalism matters not expressly covered in this policy, reference should be made to the Canadian Undergraduate Deans Statement on Professionalism, which is incorporated into this policy by reference.
4.3 In addition to the standards of professional behaviour outlined in this document, students must also adhere at all times to all University policies and procedures, including, but not limited to, Academic Integrity (Policy 60), Student Code of Non-Academic Conduct (Policy 61), Scholarly, Research and Creative Activity (SRC) Integrity (Policy 118), Discrimination and Harassment Prevention Policy, and the Sexual Violence Policy.
4.4 Professionalism is a key graduation learning outcome of the MD program. The College of Family Physicians of Canada CanMEDS-FM defines the professional role: “As Professionals, family physicians are committed to the health and well-being of their patients and society through competent medical practice; accountability to their patients, the profession, their colleagues, and society; profession-led regulation; ethical behaviour; and maintenance of personal wellbeing”2. In addition, the Royal College of Physicians and Surgeons of Canada incorporates Professionalism as a key CanMEDS role: “The Professional Role reflects contemporary society’s expectations of physicians, which include clinical competence, a commitment to ongoing professional development, promotion of the public good, adherence to ethical standards, and values such as integrity, honesty, altruism, humility, respect for diversity, and transparency with respect to potential conflicts of interest.”3
4.5 Principles of fairness and due process must apply for all parties affected by this Policy. The School is committed to providing a process that is fair, timely, unbiased and facilitative for all parties.
4.6 The School is committed to ensuring that both the student and the people impacted by student behaviour that does meet the School's standards of professional conduct receive the support and assistance they need.
4.7 A finding that a Lapse of Professionalism occurred will be made on the basis of a balance of probabilities (it is more likely than not to have occurred).
3 Royal College of Physicians and Surgeons of Canada, CanMEDS 2025, (external link)
5. Standards of Professional Conduct
5.1 MD students must meet the program’s standards of professionalism to progress in and graduate from the program. Students in the MD program will:
5.1.1 follow all university and program regulations, policies, and procedures such as but not limited to: clinical placement policies, immunization reporting, and those regarding academic and non-academic conduct.
5.1.2 exhibit appropriate professional behaviour in all verbal, written and electronic correspondence, including and not restricted to social media, while at all times maintaining confidentiality, respecting privacy and professional boundaries as required and avoiding derogatory or inappropriate discussion about peers, staff, faculty, patients and healthcare providers.
5.1.3 demonstrate respect for others’ rights and feelings, including treating everyone with courtesy and respect, using inclusive language, resolving conflicts respectfully and refraining from discriminatory or harassing behaviour.
5.1.4 support the learning process for themselves and others, including attending classes and placements regularly, being prepared, participating actively and taking responsibility for their learning.
5.1.5 provide constructive feedback on teaching, supervision and learning events.
5.2 According to the School of Medicine’s standards of professional conduct:
5.2.1 Students are expected to demonstrate exemplary professional behaviour in all academic and clinical settings, reflecting their role as developing healthcare professionals.
5.2.2 High standards of Professionalism should permeate all aspects of the medical education environment.
5.2.3 The provision of safe and effective patient and team-based care requires professional behaviour.
5.2.4 Medical students in the MD program are integral to the delivery of safe and effective patient care and team-based processes. Students are therefore required to uphold high standards of professional behaviour in all these processes.
5.2.5 Adherence to the core principles of Professionalism is a mandatory requirement for graduation.
5.2.6 Professionalism is a competency that develops longitudinally and can be learned through: increased self-awareness, self-analysis, feedback acceptance, coaching and mentorship, and learning from and correcting outcomes.
5.2.7 Professionalism includes advocacy for change to achieve health equity, the elimination of health disparities and the advancement of health as a human right through the delivery of culturally-sensitive and culturally-safe healthcare. Also encompassed in professionalism is the promotion of social justice, equity, diversity, inclusion, and accessibility (EDIA) as well as Reconciliation and Indigenous Health.
5.2.8 Lapses in Professionalism should be addressed through support and resources to facilitate professional identity formation and address underlying issues, including but not limited to: student burnout, illness or socio-cultural factors. The School will offer support and other interventions for self growth, through the LAU and a plan created at the UGME Student Progress Subcommittee of the UGME Competence Committee.
5.2.9 Professionalism concerns must be reported promptly according to the Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program Procedures that accompany this Policy.
5.2.10 Concerns of student conduct related to Academic Integrity (Policy 60), Student Code of Non-Academic Conduct (Policy 61), Scholarly, Research and Creative Activity (SRC) Integrity (Policy 118), Discrimination and Harassment Prevention Policy, and Sexual Violence Policy or other university policies and procedures should be reported through the relevant procedures outlined in these policies and may be processed jointly with the School of Medicine. A finding of academic misconduct, non-academic misconduct, SRC misconduct, discrimination, harassment, sexual violence or other violations under University policies and procedures will be considered a Lapse of Professionalism and will be addressed as such.
5.2.11 Lapses in Professionalism will be documented in the Medical Student Performance Record as outlined in this policy’s Procedure Section as well as in Appendix A, adapted from the AFMC’s (PDF file) Canadian Undergraduate Deans Statement on Professionalism (external link) , and will impact a student’s progression through the program.
6. Classification of Concerns Regarding Professional Behaviour
Incidents that raise concern about professional behaviour will be classified by the Associate Dean UGME or designate, into the following levels of increasing severity based on the nature and seriousness of the misconduct in question and all relevant circumstances. The classification is based on three key criteria: chronicity, harm and awareness.
Non-exhaustive examples of each of the four levels may be found in the table in Appendix 1, which is taken from the Association of Faculties of Medicine of Canada’s (PDF file) Canadian Undergraduate Deans Statement on Professionalism (external link) .
6.1 A Level 1 concern meets the following criteria:
- first Professionalism concern; and
- no or very minor direct or indirect past or ongoing harm to others (faculty, other students, patients, the public or institutions); and
- student acknowledges and accepts responsibility for incident; and
- potential to be remediated with, but not limited to, education, apology and/or reflection.
6.2 A Level 2 concern meets the following criteria:
- previous Level 1 concern(s) or
- minor direct or indirect past or ongoing harm to others (faculty, other students, patients, the public or institutions). Includes reputational harm; or
- student lacks insight into the concerns raised by the incident; and
- potential for remediation through, but not limited to, education, apology, reflection, and/or formal course of study.
6.3 A Level 3 concern meets the following criteria:
- previous Level 1 or 2 concern(s) that persist despite remediation; or
- significant, or potential for significant, direct or indirect past or ongoing harm to others (faculty, other students, patients, the public or institutions); and
- student shows limited insight into the concerns raised by the incident; and
- potential for remediation through a formal program(s) and reassessment.
6.4 A Level 4 concern is any one of:
- multiple previous Professionalism concerns documented; or
- failure to remediate previous concerns of Professionalism; or
- regardless of previous record, egregious, or potential for egregious, harm to others (faculty, other students, patients, the public or institutions); or
- behaviour potentially inconsistent with a future career in medicine.
7. Determining The Outcome Of A Lapse Of Professionalism
Following a finding of a Lapse of Professionalism, the Associate Dean UGME or designate may implement or impose any remedy, sanction, or outcome that is appropriate in the circumstances.
Non-exhaustive examples, remedies, sanctions, and outcomes of a decision of a Lapse in Professionalism are summarized in Appendix 1.
7.1 Factors in Determining the Outcome of a Lapse in Professionalism
Decisions concerning the outcome of a Lapse in Professionalism will take into account the following:
- the nature and seriousness of the misconduct in question;
- the impact of and/or risks associated with the misconduct in question;
- the level at which the lapse is classified;
- the history of previous lapses of professional behaviour by the student;
- the level of responsibility shown by the student;
- extenuating and mitigating circumstances;
- the principle of proportionality; and
- other relevant circumstances, considerations, and contextual factors.
Level 1 to 3 Lapses in Professionalism are viewed first as an opportunity for education. The intent is to provide opportunities for students to become conscious of their professional obligations and learn how to alter their behaviour accordingly. Whenever possible, consequences should reflect this intent. Alteration in a personal learning plan, supported by the MD Program and the LAU, may be undertaken if requested by the UGME Student Progress Subcommittee, with outcomes documented.
Level 1 to 2 Lapses in Professionalism will be recorded within the School’s Learning Management System but not in the MSPR. In some cases, the lapse may also be included in the official student record. It will not if successfully remediated and non-recurrent.
Level 3 Lapses in Professionalism may be recorded in the student MSPR.
Level 4 Lapses in Professionalism will be seen as potentially incompatible with a future career in medicine, will be recorded in the School’s Learning Management System and may result in the student’s Dismissal from Program (DFP) and being ineligible for an MD Degree.
Decisions will reflect a reasonable and fair response to the Lapse of Professionalism in accordance with Appendix 1.
8. Appeals
A decision of a Lapse in Professionalism that is unrelated to another TMU policy may be appealed through the UGME Appeals process. Appeals may only be submitted on the basis that the decision was unreasonable and, specifically, must be based on at least one of the following grounds:
- School policies, procedures, and regulations were not followed; or
- Relevant evidence was not considered in the decision rendered; or
- The decision is not supported by the evidence that was available to the decision maker(s) when the decision was made.
An appeal of a decision of a Lapse in Professionalism unrelated to another TMU policy must be submitted in writing with supporting documentation to the Dean of the School of Medicine within 10 days of receipt of the decision.
In circumstances where a Lapse in Professionalism engages another TMU policy or policies, the relevant appeal process(es) engaged will be used. While an appeal of this nature is ongoing, the School reserves the right to implement or maintain any interim measures necessary to protect the integrity of the University policies and procedures, health and safety interests, or other relevant circumstances and University and affiliate interests.
9. Privacy And Confidentiality
9.1 Students’ personal information will be collected, used, and disclosed in accordance with University policies and applicable legislation.
9.2 All documentation received regarding Professionalism concerns will be collected, maintained and disposed of in accordance with Toronto Metropolitan University’s records management, records retention schedule, privacy and information classification policies, procedures and standards.
Related Policies:
Policy 61: Student Code of Non-Academic Conduct
Policy 118: Scholarly, Research, and Creative Activity (SRC) Integrity
Senate Policy 157: Establishment of Student Email Accounts for Official University Communication
Policy 174: Attendance and Absence Policy for Students in the Doctor of Medicine (MD) Program
Discrimination and Harassment Prevention Policy
Appendix 1
(From the Association of Faculties of Medicine of Canada’s Canadian Undergraduate Deans Statement on Professionalism)
Level of Concern |
Professionalism Concern: |
Examples included but are not limited to: |
Potential interventions included but not limited to: |
Documentation Principles: |
|---|---|---|---|---|
Level 1 Concerning Behaviour Requiring Intervention
|
A first-time concern and No or very minor harm to others (patients, other students, faculty, the public or institutions), and Acknowledgement and acceptance of responsibility and Potential for remediation with, but not limited to education, apology and/or reflection |
Examples below maybe Level 1 or Level 2 depending on if a recurrent professionalism lapse: Submitting an assignment late. Arriving late for a mandatory learning activity or clinical learning experience without valid reason. Missing a mandatory session without a valid reason. Communication that may be perceived as Inappropriate or disrespectful (verbal or written, including social media, etc.). Receiving or responding to feedback inappropriately. Repeated failure to meet deadlines or respond promptly to calls, particularly when patient care may be impacted. Minor, unintentional incidents of academic misconduct. |
Conversation to review the incident and identify underlying causes, opportunity for reflection, provide support and improve future performance | No further review or permanent documentation required although record of the encounter should be retained by the reviewing party in the event of future issues. |
Level 2 Concerning Pattern of Behaviour Requiring Intervention
|
Previous Level 1 concern(s) or Minor direct or indirect harm to others (as above) or Lack of insight into the concerns raised by the incident, and Potential for remediation through, but not limited to, education, apology, reflection, and/or formal course of study
|
see above | Conversation to review the incident and identify underlying causes, opportunity for reflection, provide support and improve future performance. A program of remediation to include elements such as:
|
Documentation in UGME Office academic file but no record on transcript and/or MSPR if remediation successfully completed and no further transgressions. |
Level 3 Concerning Pattern of Behaviour Persisting Following Remediation
OR Threatening or dangerous behaviour requiring major intervention |
Previous Level 1 or 2 concerns that persist despite remediation, or Significant, or potential for significant harm to others (as above), and Student shows limited insight into the concerns raised by the incident, and Potential for remediation through formal programs(s) and reassessment
|
Demonstrating a pattern of not responding to call for assistance Failing to communicate absences in a timely fashion Incidents of academic misconduct as defined by each university’s policy on academic misconduct Breaching of patient confidentiality Inappropriate or offensive communication (verbal or written, including social media, etc.) Engaging in discriminatory communication or behaviour (depending on context /egregiousness) |
Conversation to review the incident and identify underlying causes, opportunity for reflection, provide support and improve future performance A program of remediation to include elements such as:
|
Documentation in UGME academic file and Inclusion in the MSPR recommended |
Level 4 Behaviour Potentially Incompatible
|
Multiple previous Professionalism concerns documented, or Failure to remediate previous concerns, or Egregious or potential for egregious harm to others (as above), or Behaviour inconsistent with a future career in medicine
|
Physically or sexually assaulting a patient, colleague, faculty, or staff Breaching the Criminal Code of Canada with a conviction relevant to the practice of medicine and/or the learner’s role as a university student Unwelcomed and inappropriate communication or contact, where the behaviour is known or reasonably ought to be known to be unwelcomed. Unauthorized and intentional release of or accessing confidential information Engaging in discriminatory communication or behaviour (depending on context / egregiousness)
|
Conversation to review the incident and identify underlying causes, opportunity for reflection, provide support and improve future performance if appropriate in the context of the behaviour. A program of remediation to include elements such as:
Dismissal from medical school |
Documentation in UGME academic file and inclusion in the MSPR
|
Procedures: Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program
(MD) ProgramPOLICY on Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program.
The Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program Procedures (the “Procedures”) outline the processes to be followed in carrying out the Policy on Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program Students.
1. Reports of Professional Concerns
1.1 Notification Methods
Reports of Professionalism concerns may be received by the UGME Office by way of communication/report via the relevant notification form from:
- Institutional stakeholders: Originating from any member (e.g., students, staff, faculty, leaders) within the School of Medicine or any faculty/unit/process within TMU or other academic institutions (in Canada or international);
- Clinical or community partners: Sent from affiliated healthcare facilities such as hospitals, community clinics or organizations, or other;
- Regulatory body (i.e., the College of Physicians and Surgeons of Ontario or CPSO);
- Any additional unspecified sources.
1.2 Assessment Process
1.2.1 Serious allegations of unprofessional conduct and/or concerns related to patient care and/or safety, and safety of other students, residents, staff or faculty should be promptly brought forward to the attention of the Associate Dean UGME, who will acknowledge receipt of the concern within two business days. Serious allegations that impact the safety of fellow students, TMU faculty or staff, patients or families will result in an immediate response and a decision on any interim measures that will be implemented in the circumstances, including, without limitation, the student’s leave of absence from studies in the program while this is being investigated.
1.2.2 The student against whom the professional concern has been raised will be informed of the professional concern(s) by written correspondence sent by email from the Associate Dean UGME. Within five business days of being informed of the concern the student will be required to meet with the Associate Dean UGME and a leader in the Learner Affairs Unit, and they will be given the chance to file a written submission before the meeting occurs. The student will be allowed to bring a colleague, support person or an advocate authorized by the School to the meeting. It is expected that students will make verbal submissions and give evidence on their own. Prior to the meeting the Associate Dean UGME will request and review all relevant documentation pertaining to the professional concern.
After the meeting, the Associate Dean UGME will decide whether there is sufficient information to make an immediate decision. If so, the decision as well as a possible action plan and next steps along with its rationale, will be communicated to the student in email form as soon as practicable. The letter will include mention of services within the School and University for support and also the appeals process and associated timelines. If further investigation is needed the Associate Dean will contact the student and the Learner Affairs Unit (LAU) outlining necessary steps and a projected timeline. If the Associate Dean UGME is unable to meet the timeline, the student must be notified of when they can expect a decision.
1.2.3 Professional concerns related to academic integrity, non-academic conduct, SRC integrity, discrimination, harassment, and sexual violence will follow the procedures outlined in the relevant University policies, and a decision related to these concerns will be forwarded to the Associate Dean UGME. A finding of misconduct will be considered a Lapse of Professionalism. Its outcome will be determined by Section 7.1 in this Policy (Criteria in Determining the Outcome of a Lapse in Professionalism).
1.2.4 For professional concerns unrelated to other policies, if the Associate Dean UGME deems that additional investigation is necessary or decides that a Lapse of Professionalism has occurred, the AD UGME will recommend to the student that they meet with the LAU separately and ask for confirmation that the meeting has taken place. The student will be made aware that failure to access recommended resources may impact the outcome. In this meeting, possibilities for supportive intervention may be explored. Again, the student will be allowed to bring a colleague, support person or an advocate authorized by the School to the meeting. The timeline for action and the possible outcomes will be discussed.
1.2.5 The action and outcomes regarding some Level 3 and all Level 4 Lapses of Professionalism may result, in the judgement of the Associate Dean UGME, in a written correspondence to:
- provincial or international medical regulators (for Ontario medical students that would be the College of Physicians and Surgeons of Ontario); and/or
- future Postgraduate Medical Education programs in the Medical Student Performance Record by the Associate Dean UGME.
2. Appeals of Decisions Related to Lapses of Professionalism
2.1 Timelines for Appealing Decisions Unrelated to Other University Policies
An appeal of a decision of a Lapse in Professionalism unrelated to another TMU policy must be submitted in writing with supporting documentation to the Dean of the School of Medicine within 10 days of receipt of the decision.